Late-Life Depression Among Black and White Elderly Homecare Patients

Fyffe, Denise

doi:10.1176/appi.ajgp.12.5.531

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…RDC-defined MinD prevalence among older persons in hospice was reported as 9.2% (versus 16.9% for MDD); employing “Endicott criteria” (Endicott and Spitzer, 1979), which focus primarily on psychological depressive symptoms because neurovegetative symptoms among hospice patients are rampant, point prevalence was 12.3% for MinD and 10.3% for MDD (Chochinov et al, 1994). Three studies among older home healthcare recipients reported similar point prevalence of DSM-defined MinD (7.0, 8.2, and 10.8%) (Yewdell and Bennink, 1990; Fyffe et al, 2004). …”

Section: Resultsmentioning

confidence: 86%

A tune in “a minor” can “b major”: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

Meeks

Vahia

Lavretsky

et al. 2011

Journal of Affective Disorders

484

371

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BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980–Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2–3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8–10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.

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Section: Resultsmentioning

confidence: 86%

A tune in “a minor” can “b major”: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

Meeks

Vahia

Lavretsky

et al. 2011

Journal of Affective Disorders

484

371

View full text Add to dashboard Cite

show abstract

“…These results can be viewed within two different contexts regarding the accuracy of the depression assessment. Studies of major depression in older homecare patients (Fyffe et al, 2004) and community dwelling adults (Byers et al, 2010;Jimenez et al, 2010) have shown no racial differences in prevalence of major depression. Therefore, one might also expect that the patients in this study had no significant differences in depression prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…Despite overall increased rates of recognition of geriatric depression, disparities in depression care continue to exist for older homebound minority patients (Unützer et al, 2003;Bao et al, 2011). Although independent assessment of home healthcare (or homecare) patients demonstrated no racial differences in depression prevalence (Fyffe et al, 2004), national survey data of homecare agencies have shown lower rates of documented depression diagnosis and treatment with antidepressants in older African American homecare patients compared with that of the Caucasians (Weissman et al, 2011;Pickett et al, 2012). Rates of depression have been higher among older Hispanics with comorbid medical illness compared with those without physical complications, but the corresponding treatment rates remained low (Kemp et al, 1987).…”

Section: Introductionmentioning

confidence: 99%

Racial and ethnic variation in home healthcare nurse depression assessment of older minority patients

Pickett

Bazelais²,

Greenberg³

et al. 2013

Int J Geriat Psychiatry

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Objective To determine the racial/ethnic effect of depression symptom recognition by home healthcare nurses. Methods This is a secondary analysis of administrative data from a large, urban home healthcare agency. Patients were 65 years and older with a valid depression screen; identified as Caucasian, African American, or Hispanic; and admitted to homecare in 2010 (N=3711). All demographic and clinical information were obtained from the electronic medical record. Results Subjects were 29.34% Caucasian, 37.81% African American, and 32.85% Hispanic. 6.52% had a formal chart diagnosis of depression and 13.39 % received antidepressant therapy. The rates of positive depression screens by nurses were higher in Caucasians than African Americans or Hispanics (13.41% vs. 9.27% vs. 10.99%; [chi] 2=10.70, DF= 2; p<0.01). Depression screening rates were then stratified by the number of clinical indicators from the chart (depression diagnosis or antidepressant on medication list). The proportion of positive screen increased for minorities with an increase in the number of indicators. African Americans had significantly greater positive screens with 2 indicators compared to Caucasians and Hispanics (50.00% vs. 23.81% vs. 35.59%; [chi] 2=6.65, df=2; p=0.04). Conclusions These findings show a wide range of variation in screening for depression among ethnic groups. The rates increase for minorities with the presence of increased clinical indicators, suggesting that nurses may screen higher in minorities when there is higher clinical suspicion. Future research in home healthcare should be aimed at training nurses to conduct culturally tailored depression screening in order improved management of depression in older minorities.

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“…First, our analysis was based on an ethnically diverse sample in contrast to studies in which the patients were predominantly white. 54,55 Second, our study focused exclusively on patients over the age of 65 years in primary care settings. 56 Third, we were able to link the patient data to reports of physician identification of depression and somatization simultaneously within 6 months of interview.…”

Section: 48-53mentioning

confidence: 99%

A Cross-Sectional Study of Somatic Symptoms and the Identification of Depression Among Elderly Primary Care Patients

Bogner

Shah²,

Vries³

2009

Prim. Care Companion J. Clin. Psychiatry

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omatization, the presentation of medically unexplained symptoms, is very common in primary care.Objective: To examine the relationship between somatization and depression as rated by primary care physicians.Method: This study was a cross-sectional survey of 355 older adults with and without significant depressive symptoms. Physicians' ratings of somatization and depression were obtained for 341 of the 355 patients. Patients were sorted into 4 groups on the basis of physician ratings (no depression/no somatization, somatization only, depression only, and both somatization and depression). Data were collected from [2001][2002][2003].Results: Patients who were rated as somatizing were 4.03 (95% CI, 2.52-6.45) times as likely to be rated as depressed as well as somatizing. A comparison of the 4 groups defined by physicians' ratings found that functional status, ethnicity, number of medical conditions, depressive symptoms, and anxiety were statistically significantly different (P < .05). Primary care physicians were 3.95 (95% CI, 1.53-10.16) times more likely to identify older black patients as somatizing only versus depressed and somatizing compared to older white patients among patients above a threshold on a standard depression instrument.Conclusions: Our study fills a gap in the literature by focusing on the primary care physician ratings of depression and somatization, and also specifically on older primary care patients. Blacks are less likely to be rated as depressed, but this may reflect the tendency of doctors to rate them as somatizing.

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Late-Life Depression Among Black and White Elderly Homecare Patients

Cited by 10 publications

References 27 publications

A tune in “a minor” can “b major”: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

A tune in “a minor” can “b major”: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

Racial and ethnic variation in home healthcare nurse depression assessment of older minority patients

A Cross-Sectional Study of Somatic Symptoms and the Identification of Depression Among Elderly Primary Care Patients

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